MD Anderson Cancer Center
Japanese Medical Exchange Program 2019

Rurina Watanuki
Department of Breast Surgery
National Cancer Center Hospital

Personal Mission and Vision from JME program 2019

●Mission:（Japanese）手術によって乳房を失う乳癌患者を減らすこと（English）To diminish the breast cancer patients who lose their breasts by surgery●Vision:(Japanese）手術療法の縮小化や手術に替わる方法を生み出すことで早期乳癌患者に対して最適なボディイメージを与えること（English）To provide the best body image to my early breast cancer patients bydeveloping a de-escalating surgical strategy and creating an alternative to surgery

21. Purposea) To experience the multidisciplinary cancer care at MD Anderson Cancer Center(MDA) and understand whole concept of multidisciplinary teamb) To think and discuss how to apply multidisciplinary approach in MDA to Japanc) To learn about individual career development and the skills required for it, and build
specific individual career development plan based personal mission and vison.
2. Method
Japanese medical exchange (JME) program at MDA took place from August 22 toSeptember 27, 2019.
a) To take programs on multidisciplinary team approach, career development andleadership skill.
b) To live together with JME 2019 members of different age and disciplines during thewhole program.
c) To do group work for multidisciplinary team and create a team oncology project,and give a presentation at the end of the JME program.
Participants: 2 physicians, 2 pharmacists and 2 nurses
3. Introduction
This is my seventh year as a physician, and I have trained as a breast surgeon. Iparticipated in the 2nd team science oncology workshop from January 25 to 27, 2019 andlearned multidisciplinary team approach and career development based on mission andvision which I had never experienced before. I gained a lot from this workshop, but I
didn’t expect the next step. I was surprised to hear that I was selected as participant ofJME 2019 in April and very honored to be JME member. Thanks to understanding myboss and colleagues, they gave me willingly consent that I joined the JME program. I

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traveled to Houston with great joy and hope for the program at MDA, which everyone
involved in cancer treatment longs for.
4. Program
Clinical observations and lectures were scheduled every day in MDA. There were also
programs outside MDA and participation in academic conference held in MDA. We had
programs that 6 people joined together and sometimes we were divided into two groups
or different discipline to participate in observation and lecture.
Training programs are as follows⚫

Clinical observations with physicians, registered nurses, clinical pharmacists, nurse
practitioners, physician’s assistants and other health care providers⚫

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Breast medical oncology outpatient clinic-

Breast surgical oncology outpatient clinic-

Surgical oncology (Gastrointestinal; GI) outpatient clinic-

Breast survivorship clinic-

Stem cell plantation inpatient round-

Leukemia/Lymphoma impatient round-

Breast surgery and GI surgery observation-Pathology-

Radiation Oncology-

Breast Imaging (Radiology)-

Ambulatory treatment clinic-

WOCN (wound ostomy continence nursing) inpatient round

Lecture on nursing-

Education, professions and research in nursing-

Governance⚫

Nursing ethics conference⚫

Ethics meeting by Dr. Theriault⚫

Outside MDA-

Visit Houston hospice4

⚫

Participation in academic conference in MDA-⚫

Visit American Cancer Society
Patient Reported Outcomes in the clinical conference

Leadership training by Janis Yadney-

Introduction to leadership/communication-

Building self-awareness/handling difficult conversations-Teamwork- essential elements and your role in collaboration-

Creating your own strategic plan for your career/life⚫

Mentor-mentee meeting with Dr. Teshome⚫

Meeting with Dr. Ueno-

Winning to impact-

Individual development plan-CV-

Mentorship-Core value

5. Resultsa) Group work
We choose one topic from what we have learned in JME program and gave apresentation at the end of the program. Team B has a physician, a nurse and apharmacist. We talked about what we were interested in the third week and decided thetheme of the final presentation. For some reason, our interests were in common and wewere all surprised that there was a difference between Japanese outpatient clinic andMDA’s one. There are too many patients that a physician see at a cancer hospital oruniversity hospital in Japan per day and the consultation time per a patient is limited
despite a long waiting time. However, they form a multidisciplinary team to see apatient in MDA outpatient clinic and patients have enough time to talk with a different
discipline. It seemed that outpatients satisfaction is higher than Japanese outpatients. Infact, the survey by Ministry of Health, Labor and Welfare in Japan shows that Japaneseoutpatient satisfaction is averagely 60 %, while the survey by Press Ganey reports that itis always over 80% in MDA. Therefore, we considered what we should do to improve5

patient satisfaction in Japanese oncology outpatient clinic. During preparing apresentation, it was a great chance for me to hear frank opinions that nurses andpharmacists feel in daily clinical practice. Ayumi Tomizawa pointed out that onlydoctors are involved in making a decision for cancer treatment in nurse’s point of view.
Even if nurses like Ayumi have special skills and experiences for cancer patient care as
Certified Nurse Specialist (CNS), it’s a waste that they are not able to actively
participate in patient therapeutic decision. From the pointed of view of pharmacists, it
was pointed out that there are almost no pharmacists in outpatient clinic outside thedispensing room. I have contacted with pharmacists only by phone in outpatient
department if I need to consult with them. This is a big problem that we cannot
communicate face-to-face with each other rather than nurses. As a result, they have todeal with prescribing mistakes after the fact, which makes patients wait for a long time
to receive their medications. We should have more comfortable situation that we areable to talk and discuss with pharmacists who have expertise in cancer medication.
Physicians spend a lot of time to order examinations and prescriptions in Japan. If we
introduce medical assistants and leave these works to them, physicians can have enoughtime to see patients and communicate with them. Finally, we can build a goodrelationship with patients, which makes patient satisfaction improve. Moreover, if wedelegate the explanation about cancer medication and education about symptom
management to other specialized disciplines, physicians will have more time, andpharmacists and nurses will make good use of their expertise. By setting up a new
outpatient environment in this way, it will lead to improve other medical staffs’
motivations and raise the level of cancer patients care as a multidiscipline team.
Team B told these things through the final presentation. I think that we succeeded ingiving a good presentation and I would like to evaluate that we discussed many times in
the process of making a presentation. It was a valuable experience that I don’t haveopportunity to discuss with nurses and pharmacist for creating a project very much inJapan. Group work is sometimes more difficult than working alone and someone has totake a leadership. I felt that I need to acquire the leadership skills that makes everyone
feel phycological safety and manages the workflow. In order to do so, it is absolutelynecessary to have excellent communication skills and I did learn what is the most6

import point for multidisciplinary team care from this group work.
The mission, vision and goals of team B are as below.
Mission: To improve patients satisfaction in oncology outpatient clinic throughmultidisciplinary collaboration
Vision: To optimize medical care for cancer patients to improve their self-caremanagement skills and make them actively participate in their treatment by offering
information and education from multidisciplinary teamb) Individual career development
First of all, I was happy to be away from daily clinical practice and be able to consider
my career development for five weeks. It was a good chance to concentrate on thinkingfor myself. It was not easy for me to ask myself what I wanted to do and achieve in mycareer and express mission and vision. I was able to create my individual mission andvison in my way with advice of Dr. Ueno and my mentor Dr. Teshome (See the 1stpage). Dr. Ueno’s lectures helped me deepen my understanding of thinking methods andprocesses for making personal mission and vison. I learned a lot about the importance of7setting specific goals aligned with my personal mission and vison. I will stop going
forward and consider my career development if I wonder about it in near future. Inaddition, I got many mentors including Dr. Ueno through JME program that I would
consult with if I got lost in my career. I understood how to use my mentors and build agood mentor-mentee relationship.
6. Future prospects
First of all, I have to think how to apply the multidisciplinary team approach in MDA toJapan. It is so hard to completely emulate the success of MDA because medical
insurance system is different from the United States of America and we don’t have midlevel practitioners in Japan. However, I learned that the core of multidisciplinary teamcare was mutual understanding and respect based on great communication skills. This
point is the most lacking part of Japanese medical care and there is still room forimprovement. I want to break down the barriers between different disciplines and create
an environment that makes for smooth communication. I need to change the way ofthinking for myself, but also other people and I believe that spreading what I learned
from JME and JTOP workshop is one of the triggers. I don’t know if the narrowspecialized expertise like MDA is necessarily accepted in Japanese medicine, but eachdiscipline including physicians absolutely needs to have high level of specialty. In
addition, I would like to change the environment so that it can be used appropriately.
Second, I have to brush up my expertise in my career. It’s my challenge to find specificspecialty in the field of research as well as improving the skills of breast surgeon as aclinician. Especially, I need originality and differentiation myself from my competitors
in research. I would like to establish my narrow specialty based on my mission andvision. I also strive to work on updating my personal mission, vision and specific goals
using the way of thinking that I learned in JME program. If I am pressed by daily work,
I want to make time to “think” and don’t want to forget finding myself.
Finally, I knew that the half of skills required of health care providers are expertise, butothers are self-development skills such as communication skill and leadership skill inDr. Ueno’ lecture. It’s a challenge for me to develop this self-development skills, too. In
particular, doctors have a lot of opportunities to take a leadership and I will have to find8

how to acquire the leadership skill except daily clinical work and JTOP activities.
7. Acknowledgement
I would like to express my gratitude to Oncology Education Project that would support
JME program. I would like to show my appreciation to Dr. Ueno Naoto, Dr. Joyce
Neumaann, all US and Japanese JTOP members. In particular, the support by Mr.
Hiroshi Fueki and Ms. Marcy Sanchez was invaluable. Without special contributions
from companies and individuals, this program would not have been possible. I would
like to offer my special thanks to them. Finally, I am deeply grateful to my supervisors,colleague and loving families. I will devote myself not disgrace the name of JME
member for the development of cancer treatment in Japan.

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